Provider Demographics
NPI:1376903898
Name:VALLEY HELP AT HOME SENIOR CARE LLC
Entity Type:Organization
Organization Name:VALLEY HELP AT HOME SENIOR CARE LLC
Other - Org Name:1 ASSIST CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MPP
Authorized Official - Phone:208-557-4215
Mailing Address - Street 1:3965 W 2000 S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4012
Mailing Address - Country:US
Mailing Address - Phone:208-557-4215
Mailing Address - Fax:888-384-0874
Practice Address - Street 1:3965 W 2000 S
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-4012
Practice Address - Country:US
Practice Address - Phone:208-557-4215
Practice Address - Fax:888-384-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID008942Medicaid